Six months earlier, during the livestock show, this same space had housed champion steers and craftsmen’s booths. Gone was the manure smell and the blades of hay that embed themselves in the pattern of your soles.

Here in Houston, a patient shivering in August is never a good sign. On Monday, as Hurricane Harvey brought its third day of catastrophic rain to southeastern Texas, a steady procession of refugees sloshed into the George R. Brown Convention Center, the city’s largest emergency shelter.

Ms. Morales always made a point to look elegant. Even as a caregiver to an elderly woman, she carried herself like the Saks Fifth Avenue saleswoman she had been for many years. Last summer, she became ill, and soon her fashionable dresses hung off her like bags.

He had jaundice, the result of old red blood cells leaking into his tissues rather than being cleared from his body as waste. In medicine, this is known as a stigmata, a physical mark of illness. Oregón was dying of liver failure. A calculation made using his blood work showed that, unless he received a liver transplant, he had only an eighteen per cent chance of surviving the next ninety days.

When Pedro Faust Tzul Menchu, a 45-year-old man with colon cancer, told his oncologist he couldn’t move his leg, a medical alarm bell went off. He’d received chemotherapy a week before, so his other symptoms of vomiting and jaundice weren’t entirely surprising. But the lack of movement in his legs could have been a sign of a spinal-cord compression—when an infection or tumor strangles the nerves running up and down the spine—and potential cord compressions are always treated as an emergency. Pedro was sent straight from the oncology clinic to the hospital, where he was assigned to me as a patient. As Pedro’s hospitalist, the doctor in charge of orchestrating his care, my main job was to figure out if his spinal cord was at risk.

It is June in Houston and unseasonably dry, at least at 5:45 in the morning. Outside Ben Taub Hospital in the day’s first light, you can just begin to make out the forms of people sleeping on benches in the park across the street, patients still in paper scrubs who’ve been discharged but who have nowhere else to go. At this hour, inside the emergency room, the scene isn’t all that different.

What Cifuentes wanted more than pain medicines or chemotherapy was to die at home. Home wasn’t the small apartment he shared with fellow yard workers near the ballpark in downtown Houston. Home was a ranchito on Guatemala’s Caribbean coast. Home was with his daughter

Santiago is in the ER again. He sits in a special row of 20 patients, all of whom are waiting for one result: the potassium. Is it high enough today? Two days ago he was here, and it was only 6 meq per liter. We discharged him. Right now his chest hurts, and he is short of breath. Nothing new, and Santiago knows that if he’s to be dialyzed today, these symptoms don’t matter. Only the potassium matters.